HomeMy WebLinkAboutDisabilty_Bethe" APPUCATION FOR BLIND OR DISABLED PERSON'S ' couNTr TOWNSHIP vEa,R
, DEDUCTION FROM ASSESSED VALUATION
� > SFate Fortn d3710 (RS / 6-03) ry4+ �(�
�� PtesmOed by the Department of Loral Govemment Finance t����p ./ 1°� ,�
t9 � �
Ir�^�nation contained in this document is CONFIDENTIAL pursuant to IC 12-1-1-1(n) and IC 61.1-12 2(b . �le a
�RUCTIONS:
e (led in person or by mail with the County Audftor o( the county where the properry i cated. � ���� C T 2 2 2003
Filing Dates: 1) Real Property: During the 12 months befo2 May 11 of [he year the deduction is Ig � e 8iv .
2) Mobile Homes assessed under IC 6-1.1-7: During the 12 months before March 2 of each ye�a,'/>�the individu ywt"7shes to/�
obtain the deduction. /` / j;� _ . �e,(��,,,�f,�
of applican ner o� contract 6uyer)
e : _C'.�7 �2
licant the sole legal or equitable o eR If No, what is his/h
name on
❑ No �
applicant, indicate below
Name of contract seller _
a �i�-
Address of contract seller
Is applicant blind as defined in IC 72-1-1-1(n) and II
❑ Yes �
Is the property used and occupied primarily for hisR
� es ❑ No
� G�gSON
J�.
If owned with Someone othef lhan SpoUSe,
indicate with whom
-c�i "��� O�o�-
Is the prope i��
�iteal Prope
2-72(b)? Is applicant disabled and unable to engaga
as defined in IC 6-1.1-12(d)?
� �
Uxable gross
���a
� ❑ Mobile Home (IC 61.1-7)
i any substantial gainful adiviry
� es ❑ No
r the preceding calendar year
❑ Yes No
Page number
IIWe certify under penalty of perjury thal the above and toregoing information is true and correct and that the applicant was a resident
of Indiana and owner of ihe aforementioned property on March 1, 20 _
applicant
l
of appiicant
Signamre
____________________________